COVID-19相关黏膜毛霉病（CAM）在2021年春季在印度爆发的主要原因尚未完全理解。在此，我们提供了一项多方位和多机构的分析，对新德里大都市区CAM爆发期间的临床、病原相关、环境和保健相关因素进行了分析。我们回顾了新德里和NCR地区7家医院在2021年4月至6月期间对确诊为活检证实的CAM病人（n = 50）的所有病历。我们使用了两个多元逻辑回归模型，将与COVID-19住院当代病人（n = 69）作为对照组的CAM病例的临床特征进行比较。此外，还分析了户外气象参数和霉菌孢子浓度。选择性医院消毒样品被培养。CAM患者中的Mucorales分离物经过ITS测序和全基因组测序（WGS）分析。 多元分析确定了CAM的独立危险因素分别为先前或新诊断的糖尿病、活动性癌症和严重COVID-19感染。对COVID-19的辅助氧气治疗、雷德司韦治疗和入住ICU都与CAM风险降低有关。CAM发生率的高峰前3-4周的环境孢子浓度上升与温度升高、高蒸发和相对湿度降低有关。Rhizopus是最常见的属，但我们也发现了两例不常见的黏囊菌属Lichtheimia ornata。WGS没有发现患者分离物的克隆人口。医院灰尘中未培养出黏囊菌。宿主和环境因素的交集促成了CAM的出现。获得先进的COVID-19治疗的替代者与降低CAM风险相关。© 2023 Wiley-VCH GmbH。

The aetiology of the major outbreak of COVID-19-associated mucormycosis (CAM) in India in spring 2021 remains incompletely understood. Herein, we provide a multifaceted and multi-institutional analysis of clinical, pathogen-related, environmental and healthcare-related factors during CAM outbreak in the metropolitan New Delhi area.We reviewed medical records of all patients diagnosed with biopsy-proven CAM (n = 50) at 7 hospitals in the New Delhi, and NCR area in April-June 2021. Two multivariate logistic regression models were used to compare clinical characteristics of CAM cases with COVID-19-hospitalised contemporary patients as controls (n = 69). Additionally, meteorological parameters and mould spore concentrations in outdoor air were analysed. Selected hospital fomites were cultured. Mucorales isolates from CAM patients were analysed by ITS sequencing and whole-genome sequencing (WGS).Independent risk factors for CAM identified by multivariate analysis were previously or newly diagnosed diabetes mellitus, active cancer and severe COVID-19 infection. Supplemental oxygen, remdesivir therapy and ICU admission for COVID-19 were associated with reduced CAM risk. The CAM incidence peak was preceded by an uptick in environmental spore concentrations in the preceding 3-4 weeks that correlated with increasing temperature, high evaporation and decreasing relative humidity. Rhizopus was the most common genus isolated, but we also identified two cases of the uncommon Mucorales, Lichtheimia ornata. WGS found no clonal population of patient isolates. No Mucorales were cultured from hospital fomites.An intersection of host and environmental factors contributed to the emergence of CAM. Surrogates of access to advanced COVID-19 treatment were associated with lower CAM risk.© 2023 Wiley-VCH GmbH.